For critical illness cover to pay out, your diagnosis must align with the specific criteria in your policy and be verified by a qualified UK medical professional. In 2023, 91.3% of UK critical illness claims were paid, showing most diagnoses meet policy terms when properly documented ABI, 2023. Spirit Cover follows this standard process to ensure fairness and clarity.
The Diagnosis Process
- Policy Definition: Each covered illness - like cancer or stroke - has a precise description. For example, a heart attack might require evidence of myocardial infarction, not just symptoms like chest pain.
- Medical Verification: A UK hospital consultant with relevant expertise must confirm the diagnosis. Spirit requires this step for claim validation.
- Evidence Needed: Medical records, test results (e.g., ECGs or scans), and specialist reports are typically submitted - your adviser can assist with this.
Spirit’s Approach
Spirit Cover evaluates claims based on its list of 150 conditions (link this section to “covered conditions page). Illnesses outside these terms or less severe cases (e.g., early-stage cancers) aren’t covered unless specified. Our advisers help clarify what’s needed for a claim, keeping the process transparent.
Common Scenarios
- Cancer: Often limited to malignant cases - 50% of UK cancer patients survive 10+ years Reassured, 2025 - early stages may not qualify.
- Pre-Existing Conditions: Undisclosed conditions can lead to claim denials - full disclosure at application is essential.
What to Expect
Not every diagnosis triggers a payout - 91.3% success reflects mismatches or exclusions. Review your Spirit policy or ask us to explain what qualifies.